Denyer Steven, Eikani Carlo, Sheth Monica, Schmitt Daniel, Brown Nicholas
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
Arthroplast Today. 2023 Sep 19;23:101195. doi: 10.1016/j.artd.2023.101195. eCollection 2023 Oct.
Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery, and its diagnosis can be challenging due to the similarity of symptoms to other conditions and the lack of confirmatory imaging tests. Platelet/mean platelet volume ratio (PVR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and neutrophil/lymphocyte ratio have been proposed as potential markers to aid in the diagnosis of PJI. This study aimed to further assess the utility of these blood cell ratio combinations for the diagnosis of PJI.
A retrospective chart review was conducted on patients who presented to a university hospital for evaluation for PJI or underwent aseptic revision surgery. All patients were reviewed for inclusion in the study. Data were collected on several markers, including complete blood counts, synovial fluid white blood cell count, and polymorphonuclear percentage. Receiver operator characteristic curve analysis was used to evaluate the diagnostic capabilities of the markers and marker combinations.
The combination of erythrocyte sedimentation rate, C-reactive protein, synovial white blood cell count, and synovial polymorphonuclear percentage, with PVR, had the highest area under the curve of 0.97, with a sensitivity of 94.3% and a specificity of 88.9%, and a positive predictive value of 97.1% and a negative predictive value of 80.0%.
This study further supports the use of PVR calculated from complete blood count commonly ordered laboratory values obtained during routine complete blood counts when combined with established serum and synovial markers to increase the diagnostic accuracy for diagnosing PJI.
人工关节周围感染（PJI）是关节置换术后的一种严重并发症，由于其症状与其他病症相似且缺乏确诊性影像学检查，其诊断具有挑战性。血小板/平均血小板体积比（PVR）、血小板/淋巴细胞比、单核细胞/淋巴细胞比及中性粒细胞/淋巴细胞比已被提出作为辅助诊断PJI的潜在标志物。本研究旨在进一步评估这些血细胞比值组合对PJI的诊断效用。
对到大学医院接受PJI评估或接受无菌翻修手术的患者进行回顾性病历审查。对所有患者进行审查以确定是否纳入研究。收集了包括全血细胞计数、滑液白细胞计数及多形核百分比等多种标志物的数据。采用受试者工作特征曲线分析来评估各标志物及标志物组合的诊断能力。
红细胞沉降率、C反应蛋白、滑液白细胞计数、滑液多形核百分比与PVR的组合曲线下面积最高，为0.97，敏感性为94.3%，特异性为88.9%，阳性预测值为97.1%，阴性预测值为80.0%。
本研究进一步支持在结合既定的血清和滑液标志物时，使用根据常规全血细胞计数中常见的实验室值计算得出的PVR，以提高诊断PJI的准确性。
